Phyllis J. Kuhn, Daniel J. Olson, John P. Sullivan. Targeted Pressure on Abductor Hallucis and Flexor Hallucis Brevis Muscles to Manage Moderate to Severe Primary Restless Legs Syndrome. J Am Osteopath Assoc 2016;116(7):440–450. doi: 10.7556/jaoa.2016.088.
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Context: Restless legs syndrome (RLS) treatments have included medications with many adverse effects and limited utility. A noninvasive device would potentially have extensive use where RLS medications may not be appropriate, such as in pregnant or breastfeeding women, people with mild RLS, people who operate machinery or drive occupationally, people with severely impaired renal function, or people who are taking medications contraindicated with RLS medications.
Objective: To assess the efficacy and safety of a device that produces targeted pressure on the abductor hallucis and the flexor hallucis brevis muscles to reduce the symptoms of moderate to severe RLS, and to compare the current findings with findings from studies of ropinirole use in patients with primary RLS.
Methods: This 8-week single-arm, open-label, clinical trial with a repeated measures design was conducted between April 2009 and August 2012 in 2 offices in Erie, Pennsylvania. Adults with moderate to severe primary RLS were recruited for the study. Mean (SD) follow-up was 15.6 (6) months. Patients wore RLS devices (1 on each foot) for set periods intermittently throughout the course of the study. The primary end point was mean change in the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale from baseline to day 56, and the secondary measure was the Clinical Global Impression scale. A meta-analysis was used to compare the RLS device findings with the findings of 3 historic studies of ropinirole vs placebo. The demographics, disease severity, inclusion and exclusion criteria, and assessment tools were similar among the 4 studies.
Results: Thirty patients (22 women, 8 men; mean age, 51.5 years [range, 30-75 years]) participated in the study. Change in mean (SD) IRLSSG score was significantly greater for the RLS device (17.22 [6.16]; P<.001) compared with the ropinirole vs placebo findings (12 [0.86] vs 8.9 [0.86], respectively; P<.05). Sleep loss significantly decreased from 119.5 (61.6) minutes to 22.1 (31.1) minutes per night (P<.001). Global Improvement Scale scores indicated significantly greater improvement with the RLS device compared with ropinirole (27 of 30 [90%] vs 293 of 464 [63%], respectively; P<.05). Mild, transient adverse effects of the device (eg, pain, paresthesia) were reported, but these effects were relieved by loosening the straps. The RLS device demonstrated none of the adverse effects associated with current dopamine agonist therapy, such as augmentation, tolerance, rebound, somnolence, and nausea.
Conclusion: Producing targeted pressure on the abductor hallucis and flexor hallucis brevis muscles with an external RLS device reduced the symptoms of moderate to severe primary RLS without the adverse effects of medication therapy. (ClinicalTrials.gov number NCT02386423.) J Am Osteopath Assoc.
a International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale scores 0 (no symptoms); 1-10 (mild); 11-20 (moderate); 21-30 (severe); and 31-40 (very severe).
Abbreviation: NA, not available; RLS, restless legs syndrome.
a Data are given as mean (SD).
b Ten questions were each scored as 0 (none), 1 (mild), 2 (moderate), 3 (severe), and 4 (very severe).
c Seventeen of 30 patients (57%) responded to the follow-up survey, completed at a mean (SD) of 15.6 (6) months.
d IRLSSG scores: 0 (no symptoms);1-10 (mild), 11-20 (moderate), 21-30 (severe), and 31-40 (very severe).
Abbreviations: IRLSSG, International Restless Legs Syndrome Study Group; RLS, restless legs syndrome.
a International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale scores: 1-10 (mild); 11-20 (moderate); 21-30 (severe); and 31-40 (very severe).
Abbreviation: RLS, restless legs syndrome.
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